Intensity-modulated radiotherapy for relapsed malignant pleural mesothelioma

Our plain-English summary of Intensity-modulated radiotherapy for relapsed malignant pleural mesothelioma, by C. Spatola, C. Militello, A. Tocco, et al (Future Oncology, 2016).

The study

• Authors: C. Spatola, C. Militello, A. Tocco, V. Salamone, L. Raffaele, M. Migliore, A. Pagana, R. Milazzotto, I. Chillura, S. Pergolizzi, G. Privitera
• Journal: Future Oncology
• Published: 2016;12(23s):67-71
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The use of novel radiotherapy techniques is widely increasing, allowing clinicians to treat diseases that were previously difficult to treat with radiation therapy. Malignant pleural mesothelioma is a clear example of this clinical challenge. We describe our first experience with intensity-modulated radiotherapy technique which was used to treat a 73-year-old patient with multiple relapsing malignant pleural mesothelioma. Intensity-modulated radiation therapy has allowed to respect the QUANTEC (quantitative analyses of normal tissue effects in the clinic) dose constraints, patient has experienced a 14 months progression-free time, without relevant subacute or late lung toxicity.

In plain English

This article was a case report from a radiotherapy department in Catania, Italy. It described the authors' first use of intensity-modulated radiation therapy (IMRT) in one patient. The patient was a 73-year-old man with epithelioid malignant pleural mesothelioma of the right pleura. The disease had come back after surgery that removed the pleura and lung (extrapleural pneumonectomy) and after chemotherapy. The article did not discuss asbestos exposure. The authors compared a conventional radiotherapy plan with an IMRT plan and chose IMRT because it gave lower doses to nearby organs. The whole right chest wall and pleura received 5040 cGy in 28 fractions, with an extra 1080 cGy in six fractions to visible tumor at the lung apex. The patient completed treatment. The only side effect reported was grade II esophagitis (inflammation of the esophagus). At 14 months of follow-up he was reported free from progression and without grade II or worse lung toxicity, although the radiation dose to the right lung was above the guideline limit. The authors concluded that IMRT was a feasible option with acceptable toxicity, but stressed that this was only a case report and that more studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 73-year-old man referred to a radiotherapy department in Catania, Italy, in September 2015 with relapsed malignant pleural mesothelioma of the right pleura (epithelioid subtype). He had earlier had extrapleural pneumonectomy with hyperthermic intrapleural cisplatin chemotherapy, followed by six cycles of carboplatin–pemetrexed.
• Exposure: The article studied a treatment, not asbestos exposure. It reports no asbestos exposure history. The treatment was IMRT using eight static 'step and shoot' fields: 5040 cGy in 28 fractions to a ring covering the pleura and chest wall of the whole right hemithorax, plus 1080 cGy in six fractions to gross visible disease at the lung apex.
• Main results:
  • The authors compared the IMRT plan with a conventional 3D conformal radiotherapy plan and preferred IMRT because of the resulting doses to the organs at risk under the QUANTEC constraints.
  • The dose to the affected (right) lung, a V20 of 38%, was above the QUANTEC constraint.
  • The patient completed treatment. No grade III toxicity was detected; the only toxicity reported was grade II esophagitis.
  • At a follow-up time of 14 months, the patient was free from progression and had no relevant grade II or higher subacute or late lung toxicity.
  • At the time of the report, the patient was alive 32 months after diagnosis.
• The authors' conclusion: The authors concluded that IMRT of locally advanced or relapsing malignant pleural mesothelioma is a feasible treatment option with an acceptable toxicity profile, and that more studies are needed to validate wider use.
• Limitations the authors state:
  • The findings come from a single case, and the authors state that more studies are needed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Intensity-Modulated Radiation Therapy (IMRT), Pleural Mesothelioma.

Related studies

• Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania — C. Spatola, C. Militello, et al. (2018)
• Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study — A. Botticella, G. Defraene, et al. (2016)
• Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment — S. Lorentini, M. Amichetti, et al. (2012)
• Long-term outcomes of intensity-modulated radiotherapy following extra-pleural pneumonectomy for malignant pleural mesothelioma — Y. Matsuo, K. Shibuya, et al. (2017)
• Intensity-modulated radiotherapy is a safe and effective treatment for localized malignant pleural mesothelioma — M. Simon, T. Shochat, et al. (2018)
• Extra-pleural pneumonectomy in the era of image-guided intensity-modulated radiotherapy — M. Trovo, D. Franceschini, et al. (2019)

Browse more research in Future Oncology, or return to medical research.